Provider Demographics
NPI:1033318654
Name:ESPOSITO, JOSEPH G (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WHITE ST
Mailing Address - Street 2:ATTN CREDENTIALING DEPT
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6814
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:226 WHITE ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6814
Practice Address - Country:US
Practice Address - Phone:203-797-1500
Practice Address - Fax:203-791-0495
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004270419Medicaid
CT080008133OtherANTHEM BC
CT004270419Medicaid